Healthcare professional and patient co-design and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study

Objective: To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations.Design: Qualitative study using participatory methods (co-design workshops) and cognitive interviews. Workshop data were analysed concurrently with participants and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism.Participants: Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in two workshops. Workshop one explored principles underpinning safety feedback mechanisms, and workshop two included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients.Results: Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across three stages of the care transfer; departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer.Conclusions: Participatory, co-design principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey’s usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers.Strengths and limitations of the study: This study developed a safety survey using participatory and co-design methods to bring together patient and healthcare professional perspectives. Cognitive interviews with 28 patients were used to validate and further refine the survey format and questions. Further research is required to pilot the survey to determine whether patients would be willing to be engaged in reporting their experiences of safety following a transfer in care. Due to the nature of organisational care transfers, which potentially include large numbers of organisations, it is unlikely that participants represented all possible types of transfers that patients experience. It was not possible to explore further the governance relationships that exist between different organisations responsible for patients’ care, which could impact on the implementation of the survey into practice